Direct Deposit Form

Incorrect information on this form means that your payroll will not go through, so please double check the information before submitting.

Name*
Please use full legal name (no nicknames)

First

Last
Date of Birth*

Month

Day

Year
Social Security Number*

Format with dashes. Ex: 123-45-6789
Status*
- Married
- Single
Withholdings On W-4*
Address*

Street Address

Address Line 2

City

State

ZIP Code
Bank Name*
Account Type*
- Checking
- Savings
Account Number*

If you do not know it, please contact your bank
Routing Number*

There are 9 digits in a routing number. It can be located on the bottom of a check, or by contacting your bank
Email*

This email will be used to set up your online access to your payroll information, so we recommend using an email you have access to.
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